This invention is related to an apparatus and method for language translation between patients and caregivers, and for communicating, without speech, with persons such as hospital patients on ventilators, or other persons experiencing difficulty in communication.
Many attempts have been made over the years to provide improved methods and apparatus for facilitating communication between patients who do not speak the language of the caregiver, or who are not capable of speech. Hospital staff, doctors, and even family members visiting are often frustrated at the difficulty of communicating with patients on ventilators, or who are otherwise speech impaired. Unfortunately, such previous methods known to us have been relatively simplistic, or seem rather puzzling to the infirm or the usually somewhat mentally and/or physically incapacitated patients. As a result, there remains a significant and unmet need for an improved method and device for communication with such patients. Typical candidate patients would be those on respirators or mechanical ventilators who are unable to speak due to obstruction of their airway due to such breathing devices. Such patients are often in intensive or critical care situations with life threatening illnesses. The proper treatment of many such injuries require, or recovery could benefit from, close monitoring and rapid, accurate response to changes in the patient""s condition. However, without effective direct communication with the patient, information about that patient""s condition is often missing or incomplete, which creates the potential for incomplete or inaccurate diagnoses and treatment scenarios. Similarly, when doctors and caregivers do not have multiple language capability, and cannot speak to the patient in their own language, communication is difficult or impossible.
Additionally, patients on respirators are frustrated by not being able to ask about their condition. One important and significant problem is their inability to communicate with staff to advise of the location and intensity of pain. Patients are also often frustrated with their inability to communicate with family members about personal matters. That frustration generally compounds the patient""s anxiety, stress, and fear at being in a life threatening situation, and can often result in the need for restraints or increased medication, all of which increases the patient""s overall risk of a prolonged recovery or adverse outcome.
It is also known that the ability to effectively communicate has a considerable helpful effect on the patient""s state of mental health, as well. Patients who are already distressed by their physical condition are often further depressed by the isolation that they feel when they are not able to articulate even their most basic needs to their caregivers. Since a positive mental attitude is often essential in recovering from severe physical trauma, improved communication could directly translate into a higher level of alertness, more responsiveness, and an improved mental state. In short, a better apparatus and method for communication could result in more effective patient care, improved patient comfort, an improved patient mental state, and could be expected to speed up the time for recovery. Sometimes, it may even make the difference between life and death.
Existing methods of communicating with such patients are primitive at best. Methods often used consist of reading lips, pointing to charts of letters and pictures, or attempts at written messages. Care givers and family members alike resort to a kind of guessing game of xe2x80x9ctwenty questionsxe2x80x9d when attempting to carry on both sides of a conversation, by constructing a series of questions which have only yes or no answers until they eventually focus with some degree of certainty on what the patient wanted. Sometimes, one party, such as the family member or the patient, simply gives up the attempt to communicate, from fatigue and/or frustration. Moreover, reading lips requires training, and assumes the staff knows the language that the patient is mouthing. Importantly, such practices are impossible if there is an obstruction in the patients mouth, such as when using a ventilator, or when a significant impairs use of the mouth. Also, using a chart of letters and/or a screen of pictures is very time consuming and tiring to the patient, and requires a fairly high level of patient alertness. Written messages, while reasonably effective, can only be accomplished by a low percentage of patients who have a high level of alertness, function, and manual dexterity. All of these approaches are slow, and prone to errors and misunderstandings. At best, such prior art methods are only partially effective in the best of circumstances, and are totally ineffective for many patients, particularly for very small children and for patients who speak a foreign language.
Frequently, patients with the greatest need to communicate are the least physically able to respond. It is not unusual for patients to experience periods where only slight head or finger movements are possible. Such limitations virtually eliminate any communication which is not assisted by some technological device. The very fact that a patient is in a physical condition that requires breathing assistance generally is indicative that any prolonged physical effort to communicate would represent an extraordinary effort for that patient.
Importantly, the patient""s need for assistance with communication does not end upon being released from the Intensive Care Unit or Cardiac Care Unit (ICU/CCU) environment. Patients surviving the initial trauma of severe injury, illness, or surgery, are moved out of the critical care facility as soon as possible to free that bed for the next critical care patient. After leaving the care unit, patients may require continued support on a mechanical ventilator for an extended time period before recovering sufficiently to breath without assistance. In some cases, patients may be moved to other hospital beds, or be cared for in a nursing home or in an out-patient situation in a personal residence for weeks or months, possibly indefinitely.
Patients requiring long term care have a great and as yet still unmet need for an effective communication system, since they are often more alert and better able to function than those in intensive care, but are still unable to speak to staff or family members. Failed attempts to effectively communicate leads to additional frustration, anxiety and stress for such patients.
We have now invented, and disclose herein, a computer program based communication system, and have designed an apparatus which is effective in implementing that system. The system reliably and effectively assists patients on respirators or who are otherwise unable to speak or to communicate with hospital staff or with family members, by providing a straightforward, simple and understandable graphical user interface (GUI). Preferably, the interface is interactively accessed by the patient with the use of a touch sensitive display screen. Alternately, other input devices can be utilized, such as keyboards, a head mouse, a track ball, or other input device. Utilizing currently available thin profile monitors in combination with touch screen technology provides a simple user interface.
A key design objective, namely that the system be intuitively simple to operate so that impaired patients with no special training or prior computer experience can utilize the system to communicate effectively, has clearly been achieved. In a preferred embodiment, our apparatus features a patient monitor located on an adjustable articulated arm. A second monitor is provided, preferably on a mobile stand, to allow a caregiver or family member to view the patient""s inputs and responses. Ideally, a self contained, completely independent, roll-around hardware configuration is provided, utilizing a battery pack for long term power supply to the supporting general purpose computer. Such a preferred arrangement allows our patient communication system to be quickly moved and to be used in virtually any location. The software program provided features a large vocabulary of typical words and phrases useful in patient care, which words and phrases are grouped into sets that can be selected, usually by the patient (but also by the caregiver) for display. Also available for display are images of the human body, both male and female (both front and rear), that can be used by a patient to identify the exact location of pain or other problem they may be experiencing. Where appropriate, words appearing on graphical screen images can be replaced with pictures to assist those who cannot read, such as children. In yet another enhancement, the common phrases and word lists, further explained below, are provided in various languages, which can be selectively coupled in two-language sets, to assist in effecting two way communication between patients and staff who understand only a differing language from the patient. In the United States, for example, one common language pair which is of particular benefit is Spanish-English, where questions and answers can be posed in either language.
Our novel method and apparatus has addressed many design requirements, and has effectively met objectives to provide various novel features, in order to provide an effective solution to the special communications needs of patients, particularly those on respirators.
One design objective of our development is simplicity of the method and apparatus. This is important since patients are often elderly and not infrequently may be intimidated by computers. Thus control must be intuitive and require essentially no training or previous experience. It is a feature of the present invention that patient communication is facilitated while avoiding the necessity for patient operation of complex or difficult to manipulate equipment.
Another objective of our invention is to provide easy to use input devices. This is important since patients are frequently severely impaired, and are often found with very limited dexterity and mobility. It is a feature of our invention that the input devices provided are easy to use with little or no training. It is another feature that the method and device is adaptable for use throughout a range of input devices suitable for patients with a range of impairments.
Another objective of our invention is good visibility to the patient. This is important since many patients have poor or impaired visibility. It is yet another feature of our invention that the graphical objects on the patient""s viewing LCD screen are generally provided in large blocks that can be easily seen. Thus, our invention can be utilized by patients with poor visibility.
It is another objective of our invention that the output responses be easily understood by the staff or family. It is a feature of our invention that the responses are visible to staff and family, via separate monitor, although the patient monitor may be facing directly away from the staff, toward the patient. It is yet another important feature of our invention that both audible and visual feedback to indicate patient responses may be provided.
It is another objective of our invention that the output responses be easily communicated between speakers of differing languages. It is a feature of our invention that the responses are provided with the ability to match language pairs, so that any desirable language pair may be communicated using common words and phrases to describe the condition of the patient. It is a feature of our invention that communication between individuals of differing languages is achieved.
It is still another objective of our invention that the needs of children or others who have difficulty with words be able to communicate. One feature of our invention is the presentation of images which portray a question, answer, or response that enables communication without words. This is important since some children do not read at all.
Yet another design objective is flexibility of location and placement. It is an important feature of our invention that the patient monitor is adjustable to any location with the reasonable reach of the patient. In this manner, our novel method and apparatus may be used by patients who are lying down, who are reclined, who are sitting up in bed, or who are in wheelchairs. It is an important feature that the patient monitor provided is adjustable to a wide variety of viewing angles. Also, it is another important feature that the patient monitor be adjustable with a minimum of effort through a wide range of heights, ranging from about 30 inches to about 60 inches. Finally, it is an important feature that the patient monitor is manually adjustable, vertically, horizontally in both axes, and in tilt.
Another important and useful objective is portability. One important feature of our invention is that the apparatus is preferably provided in a portable, battery powered configuration, where the portable wheeled stand can be easily rolled between patients or rooms. This is important in locales where limited funding resources may limit the purchase of such communication devices to a minimum number, which can be shared between patients, such as when patients are sleeping.
Another design objective is structural stability, i.e., good weight and balance design. This is important since it is preferable that the patient monitor be relatively light in weight, so it can be positioned above a patient on an articulated arm, without fear of the unit injuring the patient by inadvertent downward motion. Also, it is a feature that our apparatus is designed with a relatively low center of gravity, so that it is not prone to tipping over to potentially cause further harm to the patient, or injure the caregiver, or to damage the equipment.
Still another important objective is that the unit be easily disinfected. It is an important feature of our invention that the patient touch screen, as well as other parts, are made from easily cleanable materials which can be disinfected with common hospital cleaning solutions. Moreover, it is still another feature that key electronic components are completely sealed, so as to be resistant or impervious to spill of liquids, whether contaminated or not.
Yet another objective is that the risk of electrical shock be minimized or eliminated to the maximum extent feasible. It is a feature of our battery powered unit that this objective is easily achieved, in the preferred embodiment. If is still another feature, in furtherance of this objective, that our novel apparatus provides an electrical current leakage limited to conventional specifications for hospital equipment, and is compliant with both UL and FCC specifications applicable to its use.